{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T10:03:24Z","timestamp":1771927404395,"version":"3.50.1"},"reference-count":28,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,26]],"date-time":"2026-01-26T00:00:00Z","timestamp":1769385600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aims to evaluate the clinical value of combining 3D printing technology with customized metal plates in the treatment of long-segment femoral shaft comminuted fractures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective study was conducted on 36 patients with long-segment femoral shaft comminuted fractures who were treated at our hospital between September 2020 and September 2023. Patients were divided into two groups: the conventional group (18 patients), treated with limited open reduction and intramedullary nailing, and the 3D printing group (18 patients), which utilized 3D-printed models and customized metal plates for assisted internal fixation. Intraoperative evaluation metrics included surgical time, number of fluoroscopy exposures, and intraoperative blood loss. Postoperative evaluation metrics included the time to weight-bearing initiation, time to full weight-bearing, and fracture healing time. At 3 months post-operation and at the final follow-up, evaluations were conducted on the knee flexion-extension range of motion (ROM), hospital for special surgery (HSS) score, hip flexion-extension ROM, Harris score, visual analogue scale (VAS) score, and the occurrence of complications. At the final follow-up, lateral displacement, angular deformity, shortening deformity, and the modified radiographic union score for tibia (mRUST) score of the fracture site were evaluated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The 3D printing group had significantly shorter surgical time and fewer fluoroscopy exposures (both\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001), while intraoperative blood loss was higher but not statistically significant (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.252). The 3D printing group also showed faster initiation of partial weight-bearing, full weight-bearing, and fracture healing (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.009). At 3 months and final follow-up, the 3D printing group showed significantly better knee flexion-extension ROM, HSS score, hip flexion-extension ROM, and Harris score than the conventional group (all\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001), while VAS scores showed no significant difference (all\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;gt;\u20090.05). At the final follow-up, the 3D printing group demonstrated better results in terms of lateral displacement, angulation deformity, shortening deformity, and mRUST score (all\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Combining 3D printing technology with customized metal plates in treating long-segment femoral shaft comminuted fractures improves surgical efficiency, fracture reduction and healing quality, and promotes functional recovery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fsurg.2026.1705131","type":"journal-article","created":{"date-parts":[[2026,1,26]],"date-time":"2026-01-26T07:09:11Z","timestamp":1769411351000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Combining 3D printing technology with customized metal plates for the treatment of long segment femoral shaft comminuted fractures"],"prefix":"10.3389","volume":"13","author":[{"given":"Rongda","family":"Xu","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, The Second Affiliated Hospital of Shenyang Medical College","place":["Shenyang, Liaoning, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yingying","family":"Liang","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Shengjing Hospital of China Medical University","place":["Shenyang, Liaoning, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hanfei","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Central Hospital Affiliated to Shenyang Medical College","place":["Shenyang, Liaoning, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiahui","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Central Hospital Affiliated to Shenyang Medical College","place":["Shenyang, Liaoning, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xueting","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Central Hospital Affiliated to Shenyang Medical College","place":["Shenyang, Liaoning, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ming","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, The Second Affiliated Hospital of Shenyang Medical College","place":["Shenyang, Liaoning, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hongliang","family":"Tu","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, The Second Affiliated Hospital of Shenyang Medical College","place":["Shenyang, Liaoning, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zelin","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, The Second Affiliated Hospital of Shenyang Medical College","place":["Shenyang, Liaoning, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Siyu","family":"Duan","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, The Second Affiliated Hospital of Shenyang Medical College","place":["Shenyang, Liaoning, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhencun","family":"Cai","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, The Second Affiliated Hospital of Shenyang Medical College","place":["Shenyang, Liaoning, China"]},{"name":"Liaoning Province Key Laboratory for Phenomics of Human Ethnic Specificity and Critical Illness, Shenyang Key Laboratory for Phenomics, Shenyang Medical College","place":["Shenyang, Liaoning, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,26]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"296","DOI":"10.5435\/00124635-200905000-00004","article-title":"Intramedullary nailing of femoral shaft fractures: current concepts","volume":"17","author":"Ricci","year":"2009","journal-title":"J Am Acad Orthop Surg"},{"key":"B2","doi-asserted-by":"publisher","first-page":"207","DOI":"10.1016\/S0020-1383(97)00182-4","article-title":"A technique to obtain correct rotational alignment during closed locked intramedullary nailing of the femur","volume":"29","author":"Deshmukh","year":"1998","journal-title":"Injury"},{"key":"B3","doi-asserted-by":"publisher","first-page":"e16559","DOI":"10.1097\/MD.0000000000016559","article-title":"The risk factors of nonunion after intramedullary nailing fixation of femur shaft fracture in middle age patients","volume":"98","author":"Wu","year":"2019","journal-title":"Medicine (Baltimore)"},{"key":"B4","doi-asserted-by":"publisher","first-page":"318","DOI":"10.1186\/s12893-024-02590-1","article-title":"Comparison of treatment results of femoral shaft fracture with two methods of intramedullary nail (IMN) and plate","volume":"24","author":"Hosseini","year":"2024","journal-title":"BMC Surg"},{"key":"B5","doi-asserted-by":"publisher","first-page":"380","DOI":"10.1186\/s13018-022-03275-2","article-title":"Effect of the degree of displacement of the third fragment on healing of femoral shaft fracture treated by intramedullary nailing","volume":"17","author":"Yang","year":"2022","journal-title":"J Orthop Surg Res"},{"key":"B6","doi-asserted-by":"publisher","first-page":"752","DOI":"10.1016\/j.injury.2013.10.015","article-title":"Effect of fragmentary displacement and morphology in the treatment of comminuted femoral shaft fractures with an intramedullary nail","volume":"45","author":"Lin","year":"2014","journal-title":"Injury"},{"key":"B7","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1007\/s00402-011-1375-5","article-title":"Mismatch of anatomically pre-shaped locking plate on Asian femurs could lead to malalignment in the minimally invasive plating of distal femoral fractures: a cadaveric study","volume":"132","author":"Hwang","year":"2012","journal-title":"Arch Orthop Trauma Surg"},{"key":"B8","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1186\/s12893-024-02451-x","article-title":"Surgical treatment outcomes of acetabular posterior wall and posterior column fractures using 3D printing technology and individualized custom-made metal plates: a retrospective study","volume":"24","author":"Zhang","year":"2024","journal-title":"BMC Surg"},{"key":"B9","doi-asserted-by":"publisher","first-page":"22667","DOI":"10.1038\/s41598-023-49515-1","article-title":"3D Printing technology combined with personalized plates for complex distal intra-articular fractures of the trimalleolar ankle","volume":"13","author":"Liang","year":"2023","journal-title":"Sci Rep"},{"key":"B10","doi-asserted-by":"publisher","first-page":"562","DOI":"10.1186\/s13018-024-05051-w","article-title":"Study on the efficacy of 3D printing technology combined with customized plates for the treatment of complex tibial plateau fractures","volume":"19","author":"Duan","year":"2024","journal-title":"J Orthop Surg Res"},{"key":"B11","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1080\/17434440.2017.1413347","article-title":"Computer assisted surgery in preoperative planning of acetabular fracture surgery: state of the art","volume":"15","author":"Boudissa","year":"2018","journal-title":"Expert Rev Med Devices"},{"key":"B12","doi-asserted-by":"publisher","first-page":"e0191328","DOI":"10.1371\/journal.pone.0191328","article-title":"Three-dimensional printing model improves morphological understanding in acetabular fracture learning: a multicenter, randomized, controlled study","volume":"13","author":"Huang","year":"2018","journal-title":"PLoS One"},{"key":"B13","doi-asserted-by":"publisher","first-page":"529","DOI":"10.2106\/00004623-198466040-00006","article-title":"Closed intramedullary nailing of femoral fractures. A report of five hundred and twenty cases","volume":"66","author":"Winquist","year":"1984","journal-title":"J Bone Joint Surg Am"},{"key":"B14","doi-asserted-by":"publisher","first-page":"665","DOI":"10.1016\/j.arth.2023.08.052","article-title":"High-Intensity progressive rehabilitation versus routine rehabilitation after total knee arthroplasty: a randomized controlled trial","volume":"39","author":"Jiao","year":"2024","journal-title":"J Arthroplasty"},{"key":"B15","doi-asserted-by":"publisher","first-page":"945","DOI":"10.1002\/jor.23710","article-title":"Correlation between RUST assessments of fracture healing to structural and biomechanical properties","volume":"36","author":"Cooke","year":"2018","journal-title":"J Orthop Res"},{"key":"B16","doi-asserted-by":"publisher","first-page":"1176","DOI":"10.1016\/j.injury.2012.03.022","article-title":"CT Scanogram for limb length discrepancy in comminuted femoral shaft fractures following IM nailing","volume":"43","author":"Vaidya","year":"2012","journal-title":"Injury"},{"key":"B17","doi-asserted-by":"publisher","first-page":"256","DOI":"10.1097\/BOT.0000000000001135","article-title":"Minimizing leg length discrepancy after intramedullary nailing of comminuted femoral shaft fractures: a quality improvement initiative using the scout computed tomography scanogram","volume":"32","author":"Gheraibeh","year":"2018","journal-title":"J Orthop Trauma"},{"key":"B18","doi-asserted-by":"publisher","first-page":"2745","DOI":"10.1007\/s11999-013-3292-0","article-title":"Assessing leg length after fixation of comminuted femur fractures","volume":"472","author":"Herscovici","year":"2014","journal-title":"Clin Orthop Relat Res"},{"key":"B19","doi-asserted-by":"publisher","first-page":"3366","DOI":"10.3390\/jcm10153366","article-title":"Custom 3D-printed cutting guides for femoral osteotomy in rotational malalignment due to diaphyseal fractures: surgical technique and case series","volume":"10","author":"Oraa","year":"2021","journal-title":"J Clin Med"},{"key":"B20","doi-asserted-by":"publisher","first-page":"148","DOI":"10.1007\/s43465-019-00025-1","article-title":"Design and analysis of customized fixation plate for femoral shaft","volume":"54","author":"Soni","year":"2020","journal-title":"Indian J Orthop"},{"key":"B21","doi-asserted-by":"publisher","first-page":"668","DOI":"10.1007\/s10439-016-1714-3","article-title":"Finite element-derived surrogate models of locked plate fracture fixation biomechanics","volume":"45","author":"Wee","year":"2017","journal-title":"Ann Biomed Eng"},{"key":"B22","doi-asserted-by":"publisher","first-page":"10542","DOI":"10.1038\/s41598-023-37433-1","article-title":"Structural analysis of customized 3D printed plate for pelvic bone by comparison with conventional plate based on bending process","volume":"13","author":"Jo","year":"2023","journal-title":"Sci Rep"},{"key":"B23","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1007\/s00068-023-02313-w","article-title":"Development of patient-specific osteosynthesis including 3D-printed drilling guides for medial tibial plateau fracture surgery","volume":"50","author":"Assink","year":"2024","journal-title":"Eur J Trauma Emerg Surg"},{"key":"B24","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1186\/s12891-024-07202-w","article-title":"3D Printing assisted MIPO for treatment of complex middle-proximal humeral shaft fractures","volume":"25","author":"Hu","year":"2024","journal-title":"BMC Musculoskelet Disord"},{"key":"B25","doi-asserted-by":"publisher","first-page":"15617","DOI":"10.1038\/s41598-021-94924-9","article-title":"Bone morphological feature extraction for customized bone plate design","volume":"11","author":"Wang","year":"2021","journal-title":"Sci Rep"},{"key":"B26","doi-asserted-by":"publisher","first-page":"927","DOI":"10.3390\/jpm12060927","article-title":"Does a customized 3D printing plate based on virtual reduction facilitate the restoration of original anatomy in fractures?","volume":"12","author":"Shin","year":"2022","journal-title":"J Pers Med"},{"key":"B27","doi-asserted-by":"publisher","first-page":"e17718","DOI":"10.1016\/j.heliyon.2023.e17718","article-title":"An overview of 3D printed metal implants in orthopedic applications: present and future perspectives","volume":"9","author":"Wu","year":"2023","journal-title":"Heliyon"},{"key":"B28","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1186\/s12938-016-0236-4","article-title":"3D-printing Techniques in a medical setting: a systematic literature review","volume":"15","author":"Tack","year":"2016","journal-title":"Biomed Eng Online"}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2026.1705131\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T09:11:10Z","timestamp":1771924270000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2026.1705131\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,26]]},"references-count":28,"alternative-id":["10.3389\/fsurg.2026.1705131"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2026.1705131","relation":{},"ISSN":["2296-875X"],"issn-type":[{"value":"2296-875X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,26]]},"article-number":"1705131"}}